This blog is totally independent, unpaid and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.

Friday, August 19, 2011

CAMBRIDGE, Mass. -- Among physicians and nurses, iPad adoption is expanding at a much faster rate than in the general consumer population -- and they want their electronic health records system to run on it, said speakers on a panel at the World Congress 3rd Annual Leadership Summit on mHealth. That leaves CIOs with a dilemma when it comes to hospital iPad EHR implementation: Run a native app or a desktop virtualized to the iPad?

Both have their tradeoffs. Virtualized environments offer unparalleled security -- and by extension, HIPAA compliance -- at the expense of speed and features tailored to the iPad and iOS operating system's touch screen.

Native iPad EHR systems, on the other hand, dovetail better with the iPad's design, with scrolling, page-turning and other features iPad diehards swear boost their productivity. However, these apps can also pose risks when an iPad is lost or stolen and therefore require more security safeguards. Native apps also may require in-house development or customization resources that many hospitals cannot afford.

Overall, if you can get employee buy-in for an iPad EHR implementation, said Dale Potter, senior vice president and CIO at Ottawa Hospital, it is quite economical. "These devices are six hundred bucks," Potter said. "Some medical equipment these physicians carry around -- [such as] a stethoscope -- can cost you much more than that."

Virtualization in Indiana EHR implementation

Before the "virtualization or native" decision can be made, Deaconess Health System CIO Todd Richardson said, a hospital has to decide if it will purchase iPads or let employees bring in their personal devices to use on the network. He took the latter approach for the six hospitals in his system, which serves western Kentucky, southern Indiana and southeastern Illinois.

His organization adopted the view that tablets, like cell phones, are a personal investment -- everyone who truly wants one already has one. Not only does that kind of thinking eliminate the capital outlay and need to track iPads throughout the enterprise. It also saves IT staff from policing devices for personal data and apps such as contacts and music. Furthermore, the policy prevents the "arms race" between physicians lobbying IT staff for upgrades when faster, larger-capacity iPads come to market -- users either upgrade themselves or they don't.

That said, there's no one right way and one wrong way to do an iPad EHR implementation, said Richardson, who chose to use Citrix Systems Inc. to virtualize the hospital's existing Epic Systems Inc. EHR system. "Different health care systems have different cultures, and different ways of doing things. What works in one spot clearly does not work from Santa Fe to Evansville to Waterloo, Iowa."

With the virtualized EHR implementation, no patient data is stored on the iPads. This greatly simplifies HIPAA compliance. Richardson said the difficult challenge in getting the system to work was creating wireless connectivity throughout their facilities, which include lead-lined buildings that required creative positioning of access points so physicians would not drop off the network. It became especially thorny in difficult spaces such as stairwells. After that came the issues of securing the wireless network and giving physicians priority bandwidth.

"We had the experience of a neurosurgeon calling and screaming because he couldn't connect from Owensboro [Ky.] on his iPad to check orders and things," he said, sheepishly. "When you've got a neurosurgeon screaming at you that [he] can't connect through [his] iPad, you've won the war -- and now the battle is figuring out why it's not connected."

The first and most obvious is that it seems there is genuine clinician enthusiasm to adopt user interfaces that are as intuitive and work as well as the Apple iOS interface.

The second is that there are some real issues trying to preserve both security and interactivity when an interface of this underlying complexity is being asked to interact with systems which were designed long before Android and iOS were a twinkle in anyone’s eye.

Third it is clear that Hospital IT and Support Departments have a considerable learning curve to scale with all this.

Last it seems the Health IT provider community really have some work ahead to provide attractive user experiences that will be satisfactory to the iPhone and iPad users!

2 comments:

Brian Ackland
said...

David, please take a look at what Cabrini are doing in Melbourne with iPads using the iSoft mobility suite. This article seems to ignore the use of the Web application model, the choices are not just between virtualization and native. In the same way I can safely do Internet banking from any web browser regardless of the device it is possible to do the same with healthcare. The positive feedback that we are getting from the doctors is great, and they are willing to supply their own iPad.http://www.youtube.com/watch?v=rNZ1q2EjLsU&feature=youtube_gdata_player

I agree with Brian's comment. At the Royal Hobart Hospital in Hobart we use a light-weight web-based application specifically written for the iPad and iPhone. It exposes a portion of one of our Shared Electronic medical record stores and to the end user appears as if it was a custom iOS based application. No data is stored locally and we allow BYO devices to access the information through wireless access in the hospitals. In fact the system is available state-wide, but currently with limited uptake for a number of other reasons. It was in-expensive to build, is considered far more secure than both virtualised and custom iOS based systems, and is very easy to maintain.